| NPI | 1134363203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 172V00000X Community Health Worker (Licence: FL 7321) |
| Additional Taxonomies | 251S00000X (Licence: FL 7321) |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2009-04-20 |